Lung cancer is the leading cause of cancer-related mortality in the United States, accounting for 221,200 new cases and 158,040 deaths annually (more than colon, breast and prostate cancers combined). Despite the presence of well-developed guidelines for care, adherence to these recommendations is variable and often poor. To help hospitals achieve optimal adherence to guidelines, meaningful comparative data on adherence to measurable quality indicators in lung cancer care must first be gathered in order to identify areas for improvement. Once such preliminary adherence data are available, assessing specific barriers to evidence- based care will guide the development of interventions to address the barriers. Once the interventions are combined into a quality improvement tool, systematic testing of implementation in a range of hospitals will be needed to assess efficacy, feasibility, sustainability, and generalizability. This project proposes to use a learning collaborative model to assess barriers to guideline adherence in lung cancer care and identify solutions. The ultimate goal of the proposal is to improve guideline adherence and decrease unwanted variation in lung cancer care. Lessons learned through evaluation of hospital adaptation and implementation of interventions will lead to identification of common principles that can guide diverse types of hospitals in providing effective, guideline adherent lung cancer care. This work will lead to a generalizable model to assess cancer care quality, understand the underlying reasons for variability, improve adherence to national guidelines and disseminate evidence-based best practices. The candidate, Dr. Odell, is a board-certified general thoracic surgeon with both a clinical and research focus on the treatment of lung cancer. His clinical training and prior research experience measuring outcomes and assessing interventions to optimize lung cancer treatment and working within the Illinois Surgical Quality Improvement Collaborative (ISQIC) has uniquely prepared him for this proposal. Dr. Odell's career goal is to become an independently funded investigator who combines advanced quantitative and qualitative analytics with expertise in implementation and dissemination science to facilitate effective, evidence-based cancer care though hospital-based programs. To fulfill this goal, he will need specific additional training during this award period to gain expertise in 3 areas: (1) quantitative evaluation methodology, (2) qualitative research methods, and (3) implementation and dissemination science. The mentorship team, experienced collaborators, institutional environment and robust quality improvement infrastructure of ISQIC are ideally suited to these educational goals. Finally, the project serves as an ideal vehicle for my career development objectives and will afford Dr. Odell the opportunity to directly apply the skills and techniques learned in qualitative methods, quantitative improvement principles, and implementation science and will position him to perform ongoing, innovate, independent research in cancer care delivery.